Friday 25 November 2011

Surgical management of deep infrabony pocket, maxillary left canine, 25/11/2011

The subject was a 43-year-old male with good overall health and fairly poor oral hygiene, who had recurrent episodes of pain and swelling over the left upper lip.

Examination showed no visible swelling but there was palpable loss of bone over the mesial aspect of the canine.

Intraoral periapical X ray showed the tooth to have a deep infrabony pocket extending up to the apical 1/3 of the root.

I decided on a two-part treatment, involving endodontic treatment of the tooth followed by a flap surgery with bone analogue (MTA) grafting of the pocket.

This photo essay depicts the second, surgical, phase of treatment.

Here's the X ray of the tooth prior to surgery. The bone defect is visible on one side all along the root.

The gingiva (gum) around the tooth looks normal - no reddening, swelling or discharge.

Incision made by a Number 15 Bard Parker knife:

Raising the full-thickness flap with a periosteal elevator:

Two views of the raised flap. Note the exposed root surface. Normally it should be covered by bone.

The  bone defect is visible as a deep hole on one side of the root:

Debriding the defect with a periodontal currette after ultrasonic removal of calculus and debris.

Sterile resorbable sponge:

Placing the sterile sponge in the defect:

Inserting the bone graft analogue (MTA):

Bone graft analogue in place. Note that the defect is now closed off and no longer gaping open:

The flap falls easily back into position without any tension in the wound :

Suturing the wound :

Wound closed by a single black silk suture:

I don't anticipate problems in healing, but long term success depends on oral hygiene maintenance.

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